Augusta panel weighs in on health care overhaul

Moving toward health care reform could mean some short-term pain, higher premiums and frustration when an estimated 32 million previously uninsured people crash the system, an expert panel of Augusta hospital CEOs and physician leaders said during a discussion at The Augusta Chronicle.

In the long term, though, it could mean greater gains in health for the population through better preventive care and a system that rewards quality over volume, they said.

Although reform often has been miscast as government-run or socialist medicine, future changes could lead to greater consumer information and more competition as more integration takes place among providers.

Even outside the Affordable Care Act passed this year, other reforms pushing electronic medical records and more objective data reporting will have an impact. Though some of the new health care reform law provisions -- such as requiring plans to cover preventive services including mammograms without a co-pay or deductible -- have already gone into effect, others will phase in up to 2014. Many on the panel predicted both short-term and long-term consequences.

For instance, the law allows, beginning in Oct. 1, 2012, for value-based purchasing that requires hospitals to publicly report a lot of new performance data and gives incentives for improving performance.

"In the long run, if this is a successful reform, patients are going to see improved quality as hospitals compete on measurables that they haven't been seeing yet," said Dr. Ricardo Azziz, the president of the Medical College of Georgia and the CEO of MCG Health System. "We are going to basically see better health overall as people have more access to preventive care and the overall health of the population improves.

"But in the short run, obviously they are not going to see that. They are going to see mostly the burden and not the benefit."

In the short term, for instance, premiums might go up, particularly for those with rich benefits. Better consumer information in the future should lead providers to compete in new ways, said C. Shayne George, the CEO of Doctors Hospital.

"I think you are going to have to define the value that you are going to bring," he said. "How do you differentiate yourself from another facility? We're all going to be measured on a lot of the same things. There's going to be a more educated consumer, potentially. So, they can just go to the Web site and compare and make those choices. I'm sure physicians will be a part of that process, too, when physicians come into the system and their piece of the continuum is measured as well."

Measuring success

The new law allows for physicians and hospitals to group together starting in 2012 to form accountable care organizations that would be paid for managing the health of enrolled patients, although the actual details of what those plans will look like has not been defined. Such arrangements could help in putting an emphasis on preventive care, promoting quality of care over volume of visits and changing the way the payment process sometimes drives care, said Dr. Jacqueline Fincher, of McDuffie Medical Associates, and the governor-elect of the Georgia chapter of the American College of Physicians.

"Even just a 10-year time frame could make a huge difference, because then physicians are not being paid just to move people through and work on a volume basis, they're actually being measured in terms of quality, of how well you've taken care of that patient as measured and benchmarked against your peers," she said.

It might be that hospitals will directly employ many of their physicians, as some already are starting to do, said Dr. Phillip Kennedy, the CEO of Center for Primary Care and the president of the Primary Care Association LLC.

"I think we are going to continue to see employment of physicians at a rate that we haven't seen probably in 15 to 20 years. You're already seeing it now," he said. New physicians are seeking employment directly with hospitals because of the uncertainty, which also has made some established practices more leery of adding partners, Kennedy said.

Even with new physician-hospital arrangements, the influx of new patients could change the way care is accessed, said Jim Davis, the CEO of University Hospital.

"Patients, when they walk in, may not see a doctor," he said. "They may see a dietitian, they may see a nurse practitioner or a (physician assistant)."

Hospitals also will be held accountable for ensuring good outcomes, such as making sure a patient is not readmitted within a certain amount of time after they leave, Davis said.

Meeting the needs

Republican leaders, flush with victory from Tuesday's election, have vowed to take down the health reform law. Although panelists said there are parts of it they are uncomfortable with, none expect that to happen, at least in the short term. For one thing, taking out parts of the law, such as the mandate to purchase health insurance or for most larger employers to provide it, could trip up providers such as hospitals who agreed to $155 billion in cuts for the promise of near-universal coverage.

"If you blow up the individual mandates and employer mandates, everything just falls apart," said Jim Cruickshank, the CEO of Trinity Hospital of Augusta.

Getting those 30 million or so new people covered could be tricky, he said.

"Where are we going to get the primary care and specialists to take care of this large (population)?" Cruickshank said. "It's like opening the floodgates."

The short-term solution could be federally qualified health centers, which get federal funding to help provide care for low-income and uninsured patients, he said. Belle Terrace Downtown Health Center in Augusta is one of these clinics and provides care for the uninsured in addition to insured patients such as 86-year-old Willie Edward Bussey, who has Medicare. The clinic is "more convenient" than going through a physician office, he said. Bussey was in for an after-hospital checkup after getting admitted twice in October within five days. Those kinds of re-admissions within a certain time frame likely will not be reimbursed in the future.

"They barely pay for it now, really," said Dr. LaToya Jackson, the lead physician for the clinic.

Still, she said she believes health reform will benefit her patients, particularly the uninsured, who have trouble getting some screening tests.

"Colonoscopies are very hard for me to get for people," Jackson said.

Employees will see higher health care premiums
Medicare cuts, costs

Even with health care reform begun, the most pressing concern for physicians is a 23 percent cut in Medicare payments looming Dec. 1, followed by a 6.5 percent cut Jan. 1.

The big cuts resulted from Congress continually putting off the cuts over the years, which caused the amount to keep snowballing, said Dr. Phillip Kennedy, the CEO of Center for Primary Care and the president of the Primary Care Association LLC. And that could hit home for Medicare patients immediately, he said.

"That's one of the things patients may ask me. If I have a relationship with you, certainly that's not going to affect us," Kennedy said. "But that is certainly going to affect my ability to take on new Medicare patients. If I'm just seeing people at a loss, then I can't sustain that."

Medicare was already a tough payer to sustain, said Dr. Jacqueline W. Fincher, of McDuffie Medical Associates and the governor-elect of the Georgia chapter of the American College of Physicians.

"We found in our practice if we allowed our practice to get more than 50 percent Medicare, if we went above that threshold, we started going in the red," she said.

-- Tom Corwin, staff writer

BACKGROUND:

President Obama signed into law a landmark health care reform bill March 23 that would bring near-universal coverage to a nation in which tens of millions of people are uninsured. The plan's provisions would be phased in over four years, and it is expected to expand coverage to about 95 percent of eligible Americans.

POLITICAL DEVELOPMENTS:

- An exit poll Tuesday showed 53 percent of voting seniors said the health care law should be repealed.

- On Wednesday, Obama defended the legislation as "the right thing to do."

- On Thursday, congressional Republicans vowed to force repeated votes on the repeal of the overhaul.

WHAT'S NEXT IN WASHINGTON: Obama has ruled out accepting a repeal of the health care measure but said he would be open to reasonable changes in the legislation. He contends most voters would not want to repeal provisions such as eliminating a coverage gap in Medicare prescription drugs for seniors.

-- From wire reports

Timeline of key provisions

The Affordable Care Act would be phased in over time. Republican leaders have vowed to repeal the bill.

2010

- Tax credit for health insurance for small businesses

- $250 Medicare Part D rebate for those who hit the doughnut hole and pay out of pocket

- No co-pays or deductibles for preventive care such as colonoscopies

- Eliminate lifetime limits on coverage

2011

- 50 percent discount on brand-name drugs for Medicare Part D

- Rebates from large employer plans that do not spend 85 percent on actual health care services, 80 percent for individual plans

- Allow states to generally use Medicaid dollars for home and community-based services for the disabled

2012

- Allow for Accountable Care Organizations, potentially groups of physicians and hospitals that manage care of patients to improve quality and reduce hospital admissions

- Begin Value-Based Purchasing, to require public hospital data and provide incentives to improve care

2013

- Increased Medicaid payments for primary care physicians

- Pilot programs to bundle payments for all providers (physicians, hospitals, etc.) per episode of care provided

2014

- Creation of Health Insurance Exchanges for those not offered insurance by an employer

- Mandate for most to buy health insurance

- Elimination of annual limits on coverage

- Elimination of denials for pre-existing conditions

- Increase of small-business health insurance tax credit

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